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WATER WELL WITHIN 600 FEET <br />WELL OWNER CONSENT FORM <br />Ta Whom ff may concern <br />I, Gary L. Wagner , being the owner of the <br />well(s) referenced herein, do hereby give consent for CAMAS Colorado, Inc. to <br />Construct a well (gravel mine) wnthm 600 feet of my well I am the owner of the following <br />well(s) which may be within 600 feet of the Brighton Mine <br />Well Permit Number 215794 <br />Located In the NE / NE (Qtr/QV) <br />Section 22 <br />Township 7S (S/N) <br />Range 67W (W!E) of the 6'" P M <br />County Adams ,Colorado <br />Coordinates 75oN feet (S/N) <br /> 200E feet (FJVV) <br />From the NE Y. comer of the said Section 22 <br />Well Permit Number <br />Located mthe / (Qtr/Qtr) <br />Section <br />Township (S/N) <br />Range (W/E) of the 6°i P M <br />County ,Colorado <br />Coordinates feet (SM) <br /> feet (E/V1~ <br />From the '/. comer of the said Section <br />Well Permit Number <br />Located mthe / (Qtr/Qtr) <br />Section <br />Township (SM) <br />Range (W/~ of the 6'" P M <br />County ,Colorado <br />Coordmates feet (S/N) <br /> feet (EN1~ <br />From the %a comer of the said Section <br />Signed -@'/ ~~~ Date -~~ o7Lb~' <br />Pnnted Name L~/ ~ <br />address `~l~ ~ %l-e~ri~i~ <br /> <br />W.te• Wep Consam Perm <br />subsbbda Supply Plan, and <br />bMG Exhibd G -wale Inbrmatpn <br />